a. Field of the Invention
The instant invention relates to the treatment of cardiac arrhythmias, such as atrial fibrillation. In particular, the instant invention relates to the use of electrophysiological data in order to identify potential arrhythmic driver sites so as to facilitate the termination of the arrhythmia via the application of pacing.
b. Background Art
The mechanisms of AF in patients are not well understood. For a long time, it was believed that AF in patients was due to random propagation of multiple reentrant wavelets throughout the atria. A recent intraoperative mapping study from Waldo's group suggested that left atrial (LA) sources are of importance in patients with chronic AF.
Current therapeutic interventions for AF include various pharmacological therapies, ablative, and surgical techniques. These techniques not only demonstrate variable efficacy in treating paroxysmal and/or persistent AF, they are also subject to potential adverse effects.
Recently, several experimental and clinical studies, including those by Jalife's group, Schilling's group, Waldo's group, and St. Jude Medical CRM Research, have suggested that pace-termination of AF is possible in certain circumstances, particularly where the AF is due to a regular and stable activity that drives the rest of the atria in fibrillatory conduction. See, e.g., Goldstein R N et al., “Reliable Pace Termination of Atrial Fibrillation is Possible,” Circulation 2003; 108 (Supp. IV):708; Verma A et al., “Regional Capture of Human Atrial Fibrillation by Atrial Pacing at Map-Guided Sites,” Europace 2008; 10(1):49. Prior efforts at pace-termination, however, have not been routinely successful, for example because the pacing protocol applied was inappropriate and/or not properly located.